Postoperative Pulmonary Complications

Pulmonary Complications: Diaphragmatic breathing exercises or Incentive Spirometry?
Postoperative care is an essential role in nursing practice. It prevents postoperative complications that may arise due to surgeries. Postoperative care includes a pathway of healing and recovering leading to prophylaxis of many pulmonary complications. Postoperative pulmonary complications include respiratory failure, pneumonia, and atelectasis. Preventing such complications is important in the clinical setting because it avoids a decline in patients’ well-being. I chose this topic for it is a common set of complications that arises postoperatively. Preventing these complications will avoid longer hospital stays and will also speed up the recovery time. The
purpose of this study was to compare the effect of diaphragmatic breathing exercises versus using the incentive spirometry in patients with abdominal surgery. The role of nurses in preventing postoperative pulmonary complications is significant, for “major causes of postoperative pulmonary complications…may be related to shallow breathing and monotonous tidal volume in post-operative patients” (Pattanshetty & Thapa, 2015, p. 1). These causes could be treated by the implications and nursing practice done by nurses who are the first to see postoperative patients. There are a significant number of surgical patients who undergo postoperative pulmonary complications as they “occur in 5–10% of patients undergoing non-thoracic surgery and in 22% of high risk patients” (Kelkar, 2015). This paper will delve into answering the question: In postoperative patients, is the use of an incentive spirometry more effective than deep breathing exercises in preventing pulmonary complications?
Critical Appraisal
Pattanshetty and Thapa, (2015) studied the effectiveness of the early mobilization program with the use of diaphragmatic breathing exercises versus the incentive spirometry and concluded that although both techniques help prevent postoperative complications, diaphragmatic breathing exercises are more effective than incentive spirometry. This study was based on a randomly selected, pre-post experimental design. There were thirty participants, split into two groups distributed by a coin method. The statistics of this study were gathered between April and June of 2015 (Pattanshetty & Thapa, 2015). There three variables that were used to measure this study were pain, chest expansion, and mobility. The visual Analog Scale was used in this study to measure pain. Participants were asked to mark the 10-cm line mark on the scale according to the amount of pain. The second variable used was chest expansion which was measured at 3 different places, the axillary, nipple and xiphoid in a high sitting position. Lastly, mobility was noted as independently over 10 meters, if it was under that then the patient would have shortness of breath, he would have needed to rest. These variables were noted before the study and after the intervention to see the effectiveness of either the Incentive Spirometry or the Diaphragmatic breathing exercises (Pattanshetty & Thapa, 2015). The researchers discussed that the stats presented effectiveness of both the diaphragmatic breathing exercises and the incentive spirometry used postoperatively but the results in the article also revealed that, “Chest expansion showed significant improvement at nipple (p=0.0001, p= 0.045) and xiphoid levels (p=0.005, p=0.027). Respiration rate was significantly reduced (p= 0.008) in the DBE group” (Pattanshetty, Thapa, 2015). Prem V, Bhamini Krishna Rao, and Arun Maiya Gundmi, (2011), summarize that “Diaphragmatic breathing is a more efficient breathing pattern with less muscle work causing relaxation of neck and shoulder muscles during breathing…DBE is quicker, most cost effective, and easier to learn by the subjects” (p. 119). Ultimately, the study done indicates that Diaphragmatic breathing exercise is more favored over Incentive Spirometry with the early mobilization program. For additional and developed information, refer to the Appendix attached.
Implications to practice at a Semester II level Although, in our clinical setting we apply both techniques to postoperative patients, the diaphragmatic deep breathing exercise is implemented more often. From personal experience in clinical, I have observed that Incentive spirometry is often used when patients have pre-existing pulmonary complications. In my clinical setting, I would implement the diaphragmatic breathing exercise because it shows higher effectiveness and it is a less invasive technique. I would choose to only directly implement the incentive spirometry if there is a pre-existing complication or the diaphragmatic breathing exercise has not been proven effective. It is my responsibility as a student nurse to make sure my patients are recovered from their surgery and to implement my nursing care to the best of my ability so they are healthy to go home. In the post-operative ward, where my clinical takes place we often see diaphragmatic breathing exercises done every 2 hours to clear airways, lower the risk of pneumonia, aids in supplying blood and oxygen to the lungs which stimulates circulation and reduces the risk of lung and pulmonary complications. (Med Surg, P.618). There are many other techniques that are used worldwide to prevent such complications. I was unaware of the techniques called the Benson’s relaxation and the Jacobson’s progressive relaxation technique before doing research on pulmonary complications in postoperative patients. This allowed me to change my viewpoint and become more curious and hopeful regarding other techniques that could be introduced or found from future nurses like us in the surgical wards helping to prevent such postoperative complications. After reading the articles, it is vital that we as semester II students keep an open mind on learning new ways to implement care and provide new knowledge for the health care professionals who have been using certain techniques for the longest time. If diaphragmatic breathing exercises, which is cost efficient, can prevent such critical complications, then experimenting and studying new techniques could further our practice as a nurse. CRNBC (2016) states one of the professional standards for nurses as “Knowledge-based practice”. This standard tells nurses to reach beyond just using learnt techniques from labs and experience but to explore and research new ways to treat complications that nurses are still having difficulty controlling. These standards are our accountabilities to keep in mind throughout our careers. Moving forward, I will keep an eye on recent research that will allow me to elaborate and enhance my scope of practice and give me the opportunity to better the future of my patients’. The prophylaxis of postoperative pulmonary complications is a priority that is implemented by nursing practice and vast amount of research is put into these methods to develop ways of recovering and promoting health for our patients.
Impact on Nursing and Health Care
Patients who develop post-surgery pulmonary complications have adjust to living with a chronic illness.
These patients undergo a transition, especially if the surgery was planned for. Nurses need to understand how the illness affects patients. Therefore, the articles reviewed, analyzed many techniques used in the clinical setting but diaphragmatic breathing exercises were the most effective. This shows that there is a need for further research in finding new and more effective ways on preventing pulmonary complications. Knowledge from the studies were subdivided into four segments empirical, aesthetic, personal, and ethical (Carper,1978). To implement the four ways of knowing in this topic of review, the significance of each can be elaborated. Empirical way of knowing is demonstrated by nursing literature in researching and learning techniques and procedures to better their scope of practice and to raise questions on improving the health care system. (Carper, 1987). In terms of Aesthetic, this study shows that nurses should further understand what their patients’ experience is when dealing with pulmonary complications and should view the “wholeness of the situation” (Carper, 1987) rather than just the symptoms. Although, nurses need a strong heart to face difficult situations and hear upsetting stories about the patient’s story, it is also a nurses’ responsibility to understand themselves and imagine themselves in the patient’s position so that they can implement their care
accordingly. Nurses should be able to determine whether to use the diaphragmatic breathing exercise or incentive spirometry and to decide by critically thinking even if there was no clear answer as to which would work more effectively for the certain patient. This example that should be used in the clinical setting is known as the ethical way of knowing (Carper, 1987). Furthermore, as mentioned earlier, I was unaware of other techniques that were used worldwide, one being the Jacobson’s Progressive Muscle Relaxation. This technique is generally demonstrated “among physiotherapists to induce relaxation. Jacobson’s Progressive Muscle Relaxation, the most popular approach in practice comprising diaphragmatic breathing and systematic sequence of isometric contractions, which progresses slowly throughout the body” (Prem et al., 2011, p. 117). A study which was conducted from July to September of 2011 compared the effectiveness of diaphragmatic breathing exercises versus Jacobson’s Progressive Muscle Relaxation in patients with cardiorespiratory conditions. Although this study focuses on patients’ stress level, it also helps with pulmonary complications considering that ineffective airways and shortness of breath leads to anxiety, therefore, to breath effectively, a patient needs to relax and breath efficiently. The study concluded that there was evidence which revealed that the diaphragmatic breathing technique reduced cardiorespiratory parameters compared to the Jacobson’s Progressive Muscle Relaxation technique. The results of this study indicated that “[t]he present study showed a significant decrease in systolic blood pressure (8.4mmHg), diastolic blood pressure (3.6mmHg), heart rate (6.20 beats\minute) and respiratory rate (4.57 breaths\ minute) following diaphragmatic breathing exercise (Prem et al., 2011, p. 117). Whereas, Jacobson’s Progressive Muscle Relaxation resulted in systolic blood pressure (5.73mmHg), diastolic blood pressure (4.13mmHg), heart rate (2.80 beats/minute) and respiratory rate (1.00 breaths/minute) (Prem et al., 2011, p. 117). This goes to show that diaphragmatic breathing exercises are more effective compared to Jacobson’s Progressive Muscle Relaxation. This study has enlightened me and aided me in gaining knowledge on how I can further research and find new inventions to better the future for potential patients’.
Conclusion
This paper explored the possible pulmonary complications that can occur postoperatively.
The two main techniques that were discussed were: Diaphragmatic breathing exercise and the Incentive Spirometry. These two techniques were studied to compare the effectiveness in preventing the possibility of postoperative pulmonary complications. This study was shown using a level II quantitative study. The results showed that, although both techniques were effective, diaphragmatic breathing exercise was further successful. This research contributes to nursing practice for it is a common topic that is stressed throughout the hospital and implemented in care. Both techniques are used in hospitals but now it is more clear as to which one should be frequently used. Knowledge gained from this research showed evidence informed practice by presenting data that has given me as a term ii nursing student, a clear outlook on which techniques I would utilize in the clinical setting. I acknowledge that the scope of this research focuses on the effectiveness of techniques. However, in future research, I would inquire why the health care industry is still investing so much in other more costly, invasive and less effective breathing
techniques.